Healthcare Provider Details

I. General information

NPI: 1609814557
Provider Name (Legal Business Name): ROBERT M CONLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE ANESTHESIA DEPT
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

23035 UPTON RD
PLYMOUTH CA
95669-9529
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-7705
  • Fax: 916-973-6354
Mailing address:
  • Phone: 901-268-4952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100026
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number434182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: